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General NPI Number Information
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NPI Number | 1609216829
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Entity Type | Organization
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Legal Business Name | CUBE
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 18245 E 10 MILE RD SUITE 140
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City | ROSEVILLE
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State | MI
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Zip | 48066-5807
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Country | US
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Telephone | 586-218-7532
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Fax | 586-598-9641
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Provider Business Mailing Address
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Address Line | 50486 JEFFERSON AVE
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City | NEW BALTIMORE
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State | MI
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Zip | 48047-2327
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Country | US
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Telephone | 586-883-3877
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Fax | 586-598-9641
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GERALD T TERLEP
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Credential | LMSW LPC
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Telephone | 586-218-7532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401006599
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License Number State | MI
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